Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance:: a randomized clinical trial
Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance:: a randomized clinical trial
复制标题
DOI：
10.1111/j.1464-5491.2005.01690.x
复制
发表时间：
2005-11-01
影响因子：
3.5
通讯作者：
Morabito, A
中科院分区：
文献类型：
--
作者：
Bonomo, M;Corica, D;Morabito, A
目的：大多数关于轻微妊娠代谢改变与巨大儿相关的研究都是根据国家糖尿病数据组或以前的世界卫生组织诊断阈值对葡萄糖不耐受进行分类。我们的目的是评估非常轻微的妊娠期葡萄糖耐受不良的后果，通过50 g葡萄糖刺激试验升高，随后口服葡萄糖耐量试验正常，使用更严格的Carpenter和Coustan标准（边缘性妊娠期葡萄糖耐受不良，BGGI）。方法300例BGGI妇女随机分为：A组（标准管理），B组（饮食治疗和定期监测）。另设对照组（C组）。新生儿分为巨胎、大胎（LGA）和小胎（SGA）。结果三组患者年龄、体质指数、胎次相近。B组治疗显著改善空腹血糖（从4.68 +/- 0.45降至4.28 +/- 0.45 mmol/l）和餐后2小时血糖（从6.01 +/- 0.57降至5.13 +/- 0.68 mmol/l）。分娩时B组空腹血糖（4.20 +/- 0.38 mmol/l）明显低于A组（4.84 +/- 0.45 mmol/l），也低于C组（4.31 +/- 0.39 mmol/l）。B组LGA婴儿出生率（6.0%）明显低于A组（14.0%）和C组（9.1%）。在SGA率上没有发现差异。A组新生儿Ponderal指数（2.73 +/- 0.35）高于C组（2.64 +/- 0.30）和B组（2.64 +/- 0.24），差异有统计学意义（P = 0.030）。结论：即使非常轻微的糖耐量改变也可能导致胎儿生长过度或不协调，这可以通过简单的、无创的治疗措施来预防。
Aims Most studies relating minor gestational metabolic alterations to macrosomia refer to glucose intolerance classified on the basis of the National Diabetes Data Group or previous World Health Organization diagnostic thresholds. Our aim was to evaluate the consequences of very mild forms of gestational glucose intolerance, defined by an elevated 50-g glucose challenge test followed by a normal oral glucose tolerance test, using the more restrictive Carpenter and Coustan's criteria (Borderline Gestational Glucose Intolerance, BGGI).Methods Three hundred BGGI women were randomly assigned to: Group A (standard management), Group B (dietary treatment and regular monitoring). A control group (C) was also considered. Newborns were classified as macrosomic, large (LGA), or small for gestational age (SGA).Results The three groups were similar in age, body mass index and parity. Therapy in Group B significantly improved fasting (from 4.68 +/- 0.45 to 4.28 +/- 0.45 mmol/l) and 2-h postprandial glycaemia (from 6.01 +/- 0.57 to 5.13 +/- 0.68 mmol/l). Fasting glycaemia at delivery was significantly lower in B (4.20 +/- 0.38 mmol/l) than in A (4.84 +/- 0.45 mmol/l), and was also lower than in C (4.31 +/- 0.39 mmol/l). Significantly fewer LGA babies were born to Group B (6.0%) than Group A (14.0%) and Group C (9.1%). No difference was found in the SGA rate. The neonatal Ponderal Index was higher (P = 0.030) in group A (2.73 +/- 0.35) than in C (2.64 +/- 0.30) and B (2.64 +/- 0.24).Conclusions Even very mild alterations in glucose tolerance can result in excessive or disharmonious fetal growth, which may be prevented by simple, non-invasive therapeutic measures.